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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000311

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Helen IreneMcDougall Sex Female

Date of Birth August 29, 1922 Place of Birth Glace BayCounty of Cape Breton

Name of Father James McDougall MAIDEN NAME of Mother Minnie Grant

Were the Parents married at the time of the Birth? Yes

Residence of Father when child was born Glace Bay, Cape Breton Present address of Father Deceased

Occupation of Father at Birth of child Coal Miner Place of birth of Father Maccan, Springhill, Cumberland

Race Name and present address of Physician in attendance at birth

Signature of Applicant Helen Irene McDougall Address of Applicant 12 Cottage Lane, Glace Bay, Cape Breton Date 10 July 1964

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Helen IreneMcDougall

Born at Glace Bay in the County of Cape Breton

That Helen IreneMcDougall Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on August 29, 1922

My knowledge of the fact and date of such Birth is based on the following Circumstances:

It is the date of birth as shown on the certificate of baptism, taken from the records of St. Marys Church, Glace Bay, which is enclosed. It is also the date of birth on the family bible record, certified extract enclosed.

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